Kate invites SPOT Therapy Hub’s – Senior Speech Pathologist, Emma Sharrock to talk about AAC. Emma is originally from the UK – she has a wealth of experience working with children and young people with complex communication and feeding support needs, and is particularly passionate about supporting and empowering the families of children with learning disabilities and Autism Spectrum Disorder.
In this week’s episode, Kate and Emma mostly refer to children and their use of the AAC. However, the information shared is equally applicable to adults as well.
AAC is an acronym that stands for Augmentative and Alternative Communication.
Augmentative communication is when another tool is added to support spoken communication. For example, key word signing, pictures, alphabet charts and gestures may be used alongside speech.
Alternative communication is when a tool is used in the place of spoken communication. For example, children and adults who are non-verbal and cannot effectively communicate using their voice may use an alternative form of communication to allow them to still get their message across.
In summary AAC encompasses all tools that an individual may use to support them in communicating when they cannot rely on speech alone.
The use of augmentative forms of communication is not something that is reserved for those with communication impairments. It is likely that we all adopt some form of augmentative communication at some point; for example, pointing at a picture in a restaurant menu in a foreign country where you do not speak the language, or using a gesture to signal that you want a drink in a loud public space because the person you are talking to cannot hear you.
Although these instances may happen less frequently for many of us, for children and adults with communication impairments the inability to make themselves effectively understood with their voice alone is a real challenge that they face on a daily basis. AAC is a tool that allows such individuals to communicate.
Within the aided AAC category, popular published tools include PECS (Picture Exchange Communication System), PODD (Pragmatic Organisation Dynamic Display), LAMP (Language Acquisition by Motor Planning) and Porloquo2go.
A wide variety of individuals can benefit from accessing some form of AAC to support their communication skills.
AAC is its ‘alternative’ form is most commonly used by individuals who are non-verbal and have none or very little functional speech. In Emma’s role, she often sees children who have Autism Spectrum Disorder (ASD) and rely on AAC to provide them with a voice.
AAC in its ‘augmentative’ form has a wider catch pool. Individuals who have developed spoken language but whose speech is very unintelligible will benefit from AAC to support them in getting their message across and to help the listener to understand what they are saying. This may include individuals with articulation difficulties, severe phonological disorders and verbal dyspraxia.
AAC can also benefit individuals who have developmental disabilities that impact their expressive language skills. They may be able to verbalise at the single word level but require support in order to join words together into longer phrases.
Emma often works with families who feel that they understand everything their child is trying to say and have in fact become experts in interpreting the child’s attempts to communicate. They may anticipate what the child is communicating by a simple glance or movement. Whilst this allows the child to have their needs and wants met within a highly familiar environment, parents will not always be there to translate or interpret their children. AAC allows individuals to develop autonomy and independence and provide opportunities for children to communicate with people outside of their immediate family. This is the first step to establishing meaningful friendships and relationships, which is what every parent hopes their child can achieve when first starting school.
It is a fundamental right for human beings to be able to communicate and AAC is a powerful tool that allows many individuals with communication impairments, to be able to exercise that right.
AAC allows individuals to make choices, indicate their wants and needs, reject things that they don’t like or don’t want. It can help people to comment on their surroundings, ask or answer questions.
AAC can be the key that opens the door to the world for some people, that without the tool that AAC is, would not be able to do any of the above. AAC is an individual’s voice, and we all deserve to have a voice that is heard.
This is always the first question asked of a therapist when the idea of AAC is first introduced to a family. It is also very understandable as families often seek out speech pathology support with the ultimate goal of their child talking.
The simple answer is NO.
If a child uses AAC in the form of signing, pictures or a device it will not stop or slow down their speech growth.
It is really difficult to predict the future development of speech in young children. Children with complex communication needs, for whom speech is the only focus of speech therapy intervention, could endure years of hard therapy without an effective method of communication. For some children with motor-based difficulties that impact their speech (i.e., Down Syndrome, Cerebral Palsy, Dyspraxia) they may need years of intensive therapy in order to make progress with their speech production. This could mean years without an effective way to communicate. AAC provides the child with a method of communicating, whilst they are putting in a lot of hard work to try and develop their speech skills.
Moreover, for children with ASD it is even harder to predict their prognosis and whether they will develop speech, and then if so, use it functionally to interact.
In literal terms, we know speech is a faster and more efficient means of communication than an AAC system. It is instant. This means that when an individual can use speech for a message, it is highly likely that they will use speech.
Parents often say, “will AAC may my child lazy and not bother to speak?”. When we look at the skills required in using AAC: visual discrimination of symbols on a page, moving through multiple pages of symbols to locate the intended message or construct a multi-word message, gaining attention of the communication partner, shifting attention between the AAC system and the adult to portray the message etc – we can see that speech is the ‘lazy’ option if we were to ever use the word lazy!
AAC is hard work, but it opens doors for children and allows them to experience interaction in a way that was not possible before.
Also, research shows that AAC can in fact support speech by increasing the frequency of interactions the child is having and provide clear language models within a concrete context. When AAC is implemented, sometimes we see that the emotional pressure on the child to ‘talk’ is removed, because they have a way of expressing themselves, and the child becomes less frustrated and more engaged in communication. We know that motivation is a big driving force in learning new skills.
Low-tech and high-tech are terms most commonly used to refer to different forms of aided AAC. They describe the tool that the individual uses.
Low-tech AAC refers to any form of AAC that does not require a component of technology. For example, an object, a photograph, a symbol board or a communication book.
Low tech AAC is normally paper based, which is an advantage as it can be cheaper to first implement and trial with a child to see if they are an appropriate candidate for AAC.
High-tech AAC refers to any form of AAC that requires a component of technology – this could be an iPad with a specific communication app (e.g. Proloquo2go) or a dedicated communication device that has been developed purely to be used for communication. There is a wide market of AAC devices that have been developed for individuals who primarily communicate using eye gaze. For example, children who have severe and profound motor disabilities, such as Cerebral Palsy, may use a dedicated communication device which tracks their eye movements across the screen and converts this into a message for their communication partner.
When it comes to deciding whether to trial or pursue low or high tech AAC there are many different factors to consider. It is important to determine what the child’s current communication need is, and then identify the most appropriate tool to meet that need.
It is also really important to think about where the child will be using the AAC. We all know that iPads and electronic devices are not waterproof, therefore if there is a child who is a passionate swimmer or regularly accesses hydrotherapy sessions then it is important that have access to a suitable AAC system that can be used in these environments. Low tech AAC that can be laminated or wrapped in sticky back plastic means the child can have a tool to communicate in the pool.
Adopting and using AAC might require a process of trial and error and problem solving which may be daunting. However, it is important to know that there is an AAC option out there that will work for the individual. It is all very possible and the role of the Speech Pathologist is to support families to achieve this.
In deciding what AAC system is best for any child it is important to conduct a thorough assessment. This will include
Choosing AAC is not about picking a product from ready-made devices. Each AAC is personalised to the individual’s skills, interest and experiences. Families should feel confident that there is a system that can enhance their child/loved one’s communication.
To find out more, contact us at SPOT Therapy Hub on spottherapyhub@gmail.com or 02 9389 3322. Also check out our podcasts and blogs on a variety of topics at www.spottherapyhub.com.au
